International Journal of Ayurveda and Pharma Research

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1 Int. J. Ayur. Pharma Research, 2013; 1(3): ISSN International Journal of Ayurveda and Pharma Research Research Article THE COMPARATIVE STUDY OF ADRAKADI QUATH SIDHA DUGDHA AND ASHWAGANDHA CHURNA IN THE MANAGEMENT OF ARSHAS (HEMORRHOIDS) Pradeepkumar B Jondhale 1 * Surekha Atram 2 1* H.O.D., and Associate Professor, Dept. of Shalyatantra, Chaitanya Ayurved Mahavidyalay, Sakegoan, Bhusaval, Maharashtra, India. 2 Assistant Professor, Chaitanya Ayurved Mahavidyalay, Sakegoan, Bhusaval, Maharashtra, India. Received on: 13/12/2013 Revised on: 18/12/2013 Accepted on: 24/12/2013 ABSTRACT Arshas (hemorrhoids) occurs mainly due to the vitiation of Agni, which leads to Malavasthambha (constipation) and Vimarga gamana of Apana Vayu. So obviously, the drug, which has capacity to streamline the vitiated Agni and regulate the Anulomagati of Apana Vayu, will be the drug of choice in treating Arshas. Adrakadi quath sidha dugdha possesses Ushna, Tikshna Dipana, Pachana and Vatanulomana property. Envisaging these points an attempt has been put forth to evaluate the efficacy of Adrakadi quath sidha dugdha in patients suffering from Arshas and the subject entitled The Comparative study of Adrakadi quath sidha dugdha and Ashwagandha churna in the management of Arshas w.s.r. to hemorrhoids have been selected for study. Total 60 patients of Arshas were registered for the present study. The selected patients were distributed randomly into two groups. Group A : 30 patients were treated with Adrakadi quath sidha dugdha 40 ml twice a day with water, after food for 15 days. Group B : 30 patients were treated with Ashwagandha churna 2 gm twice a day with water for 15 days. The observations and results obtained from clinical study have been analysed statistically to evaluate the significance of the curative properties of therapies. KEY WORDS: Arshas, Haemorrhoids, Adrakadi quath sidha dugdha, Ashwagandha churna. INTRODUCTION Acharya Sushruta describes various anorectal diseases which are more or less resemble with the diseases described in modern proctology. In with hectic schedule major changes in life style leads to anorectal diseases. The fast food culture has worsened the condition because these foods are devoid of fibre causing constipation. Arshas (haemorrhoids) is one of very common in society. [1] According to WHO 40% of peoples worldwide are suffer from piles. In India approximately 80% of the sufferers are in age group of 21 to 50 yrs [2]. It is common in both men and women (pregnant women). Also commonly seen in the people who work many hours in sitting position such as drivers, tailors, shopkeeper, clerk etc. once these disorders get root in any person, the vicious cycle of events is started because one condition may give rise to another. Modern conservative therapies include non-surgical modalities like injection slerotherapy, cryotherapy, manual dilatation of anus, electro coagulation, rubber band ligation, stapler etc., but these modalities requires many specialized equipments and assume associated risks. [3,4] Fortunately only 10% of patients have symptoms severe enough to require surgery, so in concern with all these condition a good Ayurvedic conservative therapy is required which include diet, life style and medicine. In Ayurveda number of medicinal yoga for the management of Arshas are mentioned. It has been the subject of study of many research scholars in previous years and most of them had studied on Available online at : Page 54

2 Pradeepkumar B Jondhale et al. Adrakadi quath sidha dugdha and Ashwagandha churna in the Management of Arshas (Hemorrhoids) Ksharkarma, Ksharsustra (medicated thread), Jalaukawacharan (application of leech) [5], different medicinal yoga orally or as local application. Arshas occurs mainly due to the vitiation of Agni which leads to Malavasthambha and Vimarga gamana of Apan Vayu. So obviously the drug which has capacity to streamline the vitiated Agni and regulate the Anulomagati of Apana Vayu, will be the drug of choice in Arshas. Adrakadi quath sidha dugdha possesses Ushna, Tikshna Dipana, Pachana and Vatanulomana property. [6 ] Envisaging these points an attempt has been made to evaluate the efficacy of Adrakadi quath sidha dugdha in Arshas [7]. MATERIALS AND METHODS Selection criteria Arshas and having complete history of disease along with 1 st to 4 th degree between the age group of 20 to 60 years irrespective of sex, religion, occupation, marital status were included in this study. Exclusion Criteria [8,9] The following patients were excluded from study. a). CA Anus and Rectum b). Perianal Abscess c). Piles with Fissure d). Piles with Fistula e). Prolapsed Rectum f). Crohn s disease g). Ulcerative colitis h). Proctitis i). Rectal polyp j). Condyloma k). Anal epithelioma l). HIV and Hepatitis Plan of study The whole study carried out at Chaitanya Ayurved Mahavidyalaya, Sakegaon, Bhusaval, Jalgaon. The systemic and local examination was done by rectal inspection, palpation per rectal digital examination and after pain relief proctoscopic examination. The finding were recorded in research proforma and diagnosis was made [10]. 1. Inspection i) Perianal skin - Colour/healthy/unhealthy/ Abnormal opening ii) Anal verge - Fissure/Sentinal tag/ Redundant fold iii) Number of external piles, if present. iv) On straining pile masses comes out of orifice : Yes / No. 2. Palpation 1. Tenderness 2. Swelling. 3. Indurations 3. Rectal examination 1. Anal Spasm 2. Feeling of mass /polyp / growth 3. Sphincter tone. 4. Proctoscopic Examination The proctoscopic examination includes : 1. Site - Internal / External / Internoexternal 2. Size - a. <1/2cm b. ½-1 cm c. 1-1 ½ cm d. 1 ½-2 cm 3. Shape - 1. Karpasphala 2. Jalaukamukh 3. Gostana 4.Nyagrodha praroha 4. Position - Primary 3 0 / 7 0 / 11 o clock 5. Base - Broad based/narrow based 6. Colour - 1) Reddish, 2) Bluish, 3) Whitish, 4) Mixed. Laboratory investigations 1. Blood investigations Hb%, TLC, DLC, ESR, BSL, BT, CT 2. Urine pathological examination - Microscopic and Routine. 3. Stool pathological examination - Microscopic and Routine (As per requirement) Treatment schedule A total of 60 patients of Arshas were registered for the present study. The selected patients were distributed randomly into two groups Available online at : Page 55

3 Group A: 30 patients were treated with Adrakadi quath sidha dugdha 40 ml twice a day with plane water after food for 15 days. Group B: 30 patients were treated with Ashwagandha churna 2 gm twice a day with plane water for 15 days. Supportive treatment (In both groups) Do s-regular strict diet and yoga, warm water sit'z bath etc. Don ts- Liquor, spicy food, sleepless nights etc. Follow up study The patients were treated on OPD basis and follow up every seven days up to 30 days. Criteria of Assessment The treatment effect has assessed on the basis of the relief of major symptoms of the disease. This has done at a period of every five days scoring pattern was adopted to determine the relief in the cardinal symptoms. 1) Gudgat Raktastrava (Bleeding) 0 Absent 1 Bleeding along with defecation as streak on stool drops after defecation. 3 Profuse bleeding. 2) Gudgat kandu (Itching) 0 Absent 1 Itching remains for 1 hour after defecation. 2 Itching remains for 1-5 hours after defecation. 3 Itching remains for whole day. Int. J. Ayur. Pharma Research, 2013; 1(3): ISSN Gudpida (Pain) 0 Absent 1 Pain remains for 1 hour after defecation 2 Pain remains for 1-5 hours after defecation. 3 Pain remains for whole day. 4) Shotha (swelling) 0 No swelling 1 Minimal swelling with venous prominence 2 Venous prominence with mucosal thickening 3 Venous prominence with mucosal thickening and prolapsed. 5) Agnimandya (Loss of Appetite) 0 Normal feeling of hunger with uncoated tongue 1 Indigestion of heavy food 2 Indigestion of normal food with heaviness in abdomen. 3 Indigestion of all kinds of food and heaviness and flatulence constantly. 6) Malavstambha (Constipation) 4 No Malavstambha 5 Evacuation of bowel after 2 days. 6 Evacuation of bowel after 3-4 days. 7 Evacuation of bowel after taking drastic purgatives. Criteria for overall assessment of therapy 1) Cured - More than 75 % 2) Marked - 50 % to 75 % 3) Improved - 25 % to 50 % 4) Incurable - Below 25 % Table 1 : Cardinal symptoms of Arshas S. No. Symptoms No. of patients Total Percentage Group A Group B 1. Gudgat Raktastrava 27 (90%) 25 (83.33%) % 2. Gudgat Kandu 26 (86.66%) 26 (86.66%) % 3. Gudapida 23 (76.66%) 25 (83.33%) 48 80% 4. Shotha 30 (100%) 30 (100%) % 5. Agnimandya 30 (100%) 25 (86.66%) % 6. Malavshtambha 30 (100%) 30 (100%) % Available online at : Page 56

4 Pradeepkumar B Jondhale et al. Adrakadi quath sidha dugdha and Ashwagandha churna in the Management of Arshas (Hemorrhoids) Table no.1 shows that maximum number of patients have suffered from Shotha (swelling) and Malavastambha i.e. 60 (100%) followed by Agnimandya 56(93.33%). Then next major symptom found to be Gudgat Kandu and Gudgat Raktastrava in patients i.e. in 86.66%. Gudpida were found in 48 (80%) and Gudgat Daha were found in 42 (70%) patients. Effect of Therapies The effect of Therapies has been presented as follow. Paired 't' Test Paired 't' test is used to work out mean reduction between two groups before and after treatment 6. Table 2: Effect on symptoms in Group A and Group B S. No. Symptom Group A Group B MR SE T-cal MR S.E t-cal 1. Gudgata Raktastrava *** *** 2. Gudgata kandu *** ** 3. Gudgata pida *** * 4. Shotha *** *** 5. Agnimandya *** *** 6. Malavastambha *** *** *p<0.05, **P<0.01, ***P<0.001 In patients of group-a treated with trial drug Adrakadi quatha sidha dugdha shown highly significant results in all symptoms while in group-b highly significant relief was found in Gudgat raktastrava, Shotha, Agnimandya and Malava-sthambha. In group-b significant relief was seen in Gudagat pida and Kandu table no.2 'Z' Test Table 3: Percentile relief in both groups S. No. Symptoms Percentage relief in Group A Percentage relief in Group B 1. Gudgata Raktastrava Gudpida Shotha Agnimandya Malavastambha It is large sample test as the total sample size is greater than 30. The symptom wise comparison between group A and group B, before and after treatment of study was made using 'z' test. The mean level along with their SD, combined SE and Z values with significance are presented in Table no.4 Table 4: Comparison between symptoms of two groups S. No. Symptoms Group A Group B Combined Z-cal AM1 SD1 AM2 SD2 SE 1 Gudgata Raktastrava ** 2. Gudgata Kandu ** 3. Gudpida Shotha ** 5. Agnimandya ** 6. Malavastambha ** *p<0.05,**p<0.01. Available online at : Page 57

5 Int. J. Ayur. Pharma Research, 2013; 1(3): ISSN While comparing both the groups the results were found different in two groups i.e. in experimental group the results were more significant than the control group. Table 5: Overall effect of therapy S. No. Relief effect No. of patients Group A Group B 1. Cured 0 (0%) 0 (0%) 2. Markedly Improved 7 (23.33) 0 (0%) 3. Moderately Improved 23 (76.66) 0 (0%) 4 Not improved 0 (0%) 30 (100%) The collective results in all symptoms were interpreted in the term of percentage and results were shown as follows. In group A, 23.33% patients had marked improvement, 76.66% patients had moderate improvement. There were no patients observed in cured and No improvement group. DISCUSSION Table no.1, 2, 3, 4 shows that experimental group results were more significant than the control group. Trial drugs has following properties 1. Adrak (Zingiber officinalis Roxb.) Uses-Agnideepan, Aampachan, Vatanuloman, Shoolprashaman 2. Punarnava (Boerhavia diffusa L.) Uses-Deepan, Mutral, Shothghna, Vayasthapan, Rasayana 3. Chitrak (Plumbago zeylanica L.) Uses-Deepan, Pachan, Truptighna, Lekhana, Bhedan, Arshoghna. Anti-implantation, radio sensitizing effect on oral CA. 4. Milk (cow) is good Anupan. All above drugs are Agnideepak (appetizer), Malavastambhak nashak (relives constipation), Arshogna (anti piles), Shothagna (antiinflamatory), Amapachak (digestive) so it breaks pathology and improve digestive enzymes and regulates G.I. disturbances [11,12]. Discussion on Probable mode of action of Adrakadi quath sidha dugdha. Agnimandya is the main cause of Arshas. Agnimandya affects Sar kitta vivechan resulting into Sthira sarbhag (undigested food) instead of Sar sarbhag due to which production of Ama increases and such continuous production of Ama leads to Malasanchaya. This is Apakva maladhikya due to improper Sarkitta Vivechan, which is in large quantity, is loaded in colon for long duration. As it is more in quantity, decreases Propulsion of faeces. Absorption of fluids from faeces occurs in large quantity resulting in Shushka mala (hard stool). To pass such Shushka mala, patients undergoes Pravahana (straining), during defecation. There is vitiation of Apana vayu due to straining during defecation gives rise to Kha-vaigunya at Purishavaha strotas, finally resulting in dilated rectal plexus and Mamsankur (Arshas) occur. On the other hand due to improper Sar kitta vivechan and formation of Asarbhag it hampers process of Dhatu formation, which results into Dhatu daurabalya. Dhatu Dourbalya, in presence of Dosha sanchaya and Maladhikya associated with straining gives rise to Arshas [13]. So from above pathological process most of the Ayurvedic texts gives more concentration for Deepana and digestion of Ama i.e. Pachana chikitsa respectively effects on Mandagni and Ama. Thus both Chikitsa brakes the pathological process of Arshas and ultimately patients get relief from signs and symptoms of Arshas. From above discussion we can sum up to that Adrakadi quath sidha dugdha formulation relief symptoms of piles i.e. regulates bowel habit, improving digestion, control of pain, Itching and shrinkage of pile mass. In this way, Adrakadi quath sidha dugdha formulation in management of piles acts as a multi dimensional approach by providing relief from symptoms in the patients suffering from piles. Available online at : Page 58

6 Pradeepkumar B Jondhale et al. Adrakadi quath sidha dugdha and Ashwagandha churna in the Management of Arshas (Hemorrhoids) CONCLUSION In Adrakadi quath sidha dugdha, maximum ingredients are having Ushna, Tikshana, Dipana, Pachana, Vedanasthapan and Shothahara properties. By virtue of these properties, it has Vedanahar (painkiller), Agnidipak, Shothahar, Kandughna, and Anulomak. Treatment of Arshas with Adrakadi quath sidha dugdha breaks Samprapti of Arshas as it increases Agni with Ushna, Tikshna, Deepana, Pachana properties and relieves Malavsthambha with its Anulomana property. Adrakadi quath sidha dugdha formulation acts as a multidimensional approach i.e. effective in reducing Gudgat daha, effective to reduce Gudpida, relief from Malavsthambha, effective in Shotha, Agnimandya. Adrakadi quath sidha dugdha is very useful to treat the Arshas in earlier stage. Finally, the study can be concluded that Adrakadi quath sidha dugdha is effective in treatment of 1 st and 2 nd degree of Arshas (Haemorrhoids). REFERANCES 1. Undergraguate surgery by-a.k.nan, Academic Publishers, Kolkata. page no A Concise Textbook of Surgery-Late Dr.K. Das, FRCS,Third Edition,June,2001 Page No A Concise Textbook of Surgery-Late Dr.K. Das, FRCS,Third Edition,June,2001 Page No Short Practice of Surgery-By-Love & Bailey, Edition- 23,page no Sushurut sahmita first part by Kaviraj Dr.Ambikadattshastri & dr. Pranjivan M. Mehta seventh edition chikitsa sthan adhyaya no. 06/13 page no Charak samhita of Agnivesh by-shri. Satya Narayan Shastri edition-2004 chikista sthan adhaya 14 page no. 416,page no.15/ Sushurut sahmita first part by Kaviraj Dr.Ambikadattshastri & dr. Pranjivan M. Mehta seventh edition chikitsa sthan adhyaya no. 06/13 page no Undergraguate surgery by-a.k.nan, Academic Publishers, Kolkata. page no A Concise Textbook of Surgery-Late Dr.K. Das, FRCS, Third Edition, June, 2001 Page No Undergraguate surgery by-a.k.nan, Academic Publishers, Kolkata. page no Dyavyaguna vigyan part-1&2 by- Dr.A.P.Deshpande,Dr.R.R.Jawalgekar 12. Bhavprakash Nighantu By-Dr.K.C.Chunekar, Dr.Gangasahay Pandey. Edition-2002, page no.396,13,14,42, Dyavyaguna vigyan part-1&2 by- Dr.A.P.Deshpande, Dr.R.R.Jawalgekar Cite this article as: Pradeepkumar B Jondhale, Surekha Atram. The Comparative Study of Adrakadi quath sidha dugdha and Ashwagandha Churna in the Management of Arshas (Hemorrhoids). Int. J. Ayur. Pharma Research 2013; 1 (3): Source of support: Nil, Conflict of interest: None Declared *Address for correspondence Dr. Pradeepkumar B Jondhale HOD and Associate Professor Dept. of Shalyatantra Chaitanya Ayurved Mahavidyalay Sakegoan, Bhusaval, Maharashtra, India. pbjondhale@gmail.com Mob Available online at : Page 59